Provider Demographics
NPI:1417750886
Name:MCLEAN, TASHAYVEON (CPNP-AC)
Entity type:Individual
Prefix:MS
First Name:TASHAYVEON
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:
Credentials:CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 LIAM ST
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-5161
Mailing Address - Country:US
Mailing Address - Phone:910-835-9557
Mailing Address - Fax:
Practice Address - Street 1:91 LIAM ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-5161
Practice Address - Country:US
Practice Address - Phone:910-835-9557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC334209163W00000X
NC202516848363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No163W00000XNursing Service ProvidersRegistered Nurse